Insurance questions

[HighRisk]

What is the name of your state (only U.S. law)? California

I just couldn't find the info I needed on the state website. It was all about applying for low-cost auto insurance and such.

I am in a very high-risk pregnancy. There is a chance I won't live through the delivery. I wish this were an exaggeration. Right now we live far from family, and it's important for us to get moved ASAP to be near our family. Without a doubt I will be on complete bed rest the third trimester, if not in the hospital. This is info from my doctor, not my interpretation. I can not safely have a vaginal birth. There are some organs too likely to rupture. No one could have foreseen these particular risks for me. I am allowed no more exercise right now than walking around our apartment.

I am on my fiance's insurance right now. His employer has been dragging their heels for 11 weeks about him transferring. We are no closer today than we were to getting a transfer. There is a location right in the town where his family is, and they ARE hiring. They need two people for his position. But his manager here won't give straight answers. To keep insurance, he can't quit and go be re-hired at the other location, though the other location is willing. There'd be the 6-month wait again that this company has. So it has to be a transfer.

He's looked into leaving the company, quite angry that they are knowingly keeping us from family when it's extremely dangerous for me to be on my own during the day. He's told them this repeatedly. But they're willing to risk my safety to not have to hire someone to replace him.

He has a potential offer with another company closer to our families. It's got about 100 people.

We are a young couple, mid-20's, who've managed to take 100% financial care of ourselves, even after I was laid off last year. We've been so opposed to taking state money that I didn't even apply for unemployment, and moved to a smaller place, sold one of our cars, etc., to lower our bills, and have done pretty well, comfortable, though not affluent. But our baby and my life is at risk now, time to suck up our pride and realize that we've been paying into certain agencies to give help when needed. So please don't insult me for even thinking about Medi-Cal. We're trying to avoid it, and it would be a last resort.

Our questions are these: Does a company of about 100 employees have to provide group insurance and, if so, what is the maximum wait period?

And, I hate to have to ask this, how long does it take to get on Medi-Cal? I really hate the idea of having to use any state aid, especially with the state as bad off as it is, but I'm trying to find a way for this baby to be born and for me to have a chance at living. Waiting until I go into natural labor, with no prenatal care, and hoping to get an ER doctor to understand my entire complicated medical history is just too risky.

Thank you for any help.

[HighRisk]

Also, no, aborting is absolutely not an option. A result of a car accident I was in (driver jumped a curb, hit me) is damage to my fallopian tubes. It's a miracle I am pregnant now. To get pregnant again would take in vitro. We are not aborting what may be our one chance.

We also were engaged before this pregnancy, so it's not a shot-gun engagement.

[cbg]

Does a company of about 100 employees have to provide group insurance and, if so, what is the maximum wait period?

Not in your state, no. There are only two states where employers of any size are required to provide health insurance and neither of them is California.

Additionally, I don't believe that in your state employers are required by law to provide coverage to "domestic partners" meaning that you may or may not be an eligible dependent under a new plan. I could be mistaken about that, though. That kind of law is changing rapidly and I may have missed a change or two.

how long does it take to get on Medi-Cal?

Sorry, I have no knowledge of this. Someone else may know, though.

[ecmst12]

You know unemployment isn't really state money, right? You and your employer pay into that system through your taxes. Of course you couldn't collect it now if you're not able to work, but on the other hand CA has a state disability program that could provide you with some income from now until after your baby is born.

If your fiance quits his job, he will still become eligible for Cobra, which will probably not be cheap, but it will cover both of you until he gets insurance with a new employer, or for at least 18 months with extension possible.

You should never feel bad about taking advantage of available state programs. They are there for a reason, and you pay into the system every day that you've worked, and will continue to after you have recovered from the birth and go back to work.

If your fiance gets a job offer, it would not be unusual or improper for him to ask about benefits before deciding whether to take it.

[cbg]

Just an FYI, in 47 states, including the posters, ONLY the employer pays into the unemployment system. Ecmst12 is in one of only 3 states where the employee makes a contribution.

[commentator]

Time to get tough. Keeping your insurance coverage is your top priority. In other words, you have insurance coverage right now, right? You are covered right now in a situation, where, in many states and for many employers, you would not be covered (fiance's insurance). If he leaves this job and goes to a new one, they will not cover your pregnancy, which is a pre-existing condition. If he quits his job, thus losing your coverage, you will very probably NOT be eligible for Medi-Cal. I don't follow exactly why he needs to quit this job anyhow. Except that they are not cooperating in transferring you. This makes him angry, because it does not meet your personal needs, but perhaps it is in the best interest of the employer to delay the transfer process.

One thing people have got to accept is that no business or state agency or government program or any other entity is in the business of making your life better. They aren't required to "understand" and try to help you out.

And as for your desperate need to move, which necessitates your giving up your medical coverage, so that your family can be close to you and take care of you, couldn't maybe one of your family members come where you are and spend this time with you, since you're in severe straits and at the present time, you do have medical coverage? You're looking at thousands and thousands of dollars in medical expenses and doctors who have been treating you, as opposed to doctors who have not been treating you in the new location. Plus, just the stress of moving may cause your pregnancy problems that staying put wouldn't. Or could you go to where someone in the family could be with you, and he continue to stay and work at his job until a transfer could be worked out?

It is sort of ironic that you've proudly refused to take money which you were legitimately entitled to (unemployment) which is not a hand out, and now you're in a situation where you are about to, by personal choice and for personal convenience, request what would be a genuine hand-out, the privilege of having one of you quit a job and give up insurance coverage you already have for this difficult pregnancy so that you can relocate to where you want to be. And have the state pay for something terribly expensive that you choose to make their expense instead of the expense of your fiance's insurance coverage. The state system is not going to look at this kindly at all.

How long will it take to get Medi-Cal? I would first call them and ask if it us going to compromise your eligiblity if he quits his job and forfeits his insurance and now you need to go on it. You may not qualify at all.

[cbg]

If he leaves this job and goes to a new one, they will not cover your pregnancy, which is a pre-existing condition.

NOT true. I can't say for sure that the poster will be covered on a new plan; domestic partners are not always eligible. BUT if she is, Federal law prohibits pregnancy from being considered a pre-existing condition on employer-sponsored group plans.

[ecmst12]

Not only can pregnancy NEVER be considered pre-existing, but when moving from one employer sponsored group plan to another, as long as there is not a gap in coverage of more then 63 days, NOTHING can be considered a pre-existing condition.

[ecmst12]

As far as getting medicaid, it's probably an advantage that they are not married yet - they won't be able to consider his income when determining her eligibility, only hers. And it wouldn't surprise me if pregnant women with no other coverage are always eligible, just a sliding scale for the cost.

[commentator]

Oops, sorry. My bad. You're right, pre-existing conditions have been practically eliminated. I do think that it is very possible this new company (even allowing they do have company insurance and that they cover domestic partners) will be very unenthusiastic about putting a new employee to work who has a domestic partner who has a substantial medical expense in the works. If they discover it, they could certainly find other reasons not to hire him.

If they don't cover domestic partners, but they do have company health insurance, isn't there something about if they get married, they are given 30 days to add this person to their insurance, and if they don't get it done, they have to wait till the annual enrollment period? I'm very unfamiliar with the whole domestic partners concept, as I'm in one of those extreme southern conservative areas.

I don't find it specifically in a very cursory look at Medi-Cal penalties and prohibitions, but in several states I am quite familiar with, personally quitting a job where you have insurance benefits to sign up on the state sponsored Medicaid program is not kosher. Don't know how being covered by someone else's insurance and then them quitting their job would be regarded. Not saying you couldn't qualify, it will just take extra looking at. And as long as the two of them are in a household situation, married or not, where they share meals, etc. she is not going to be considered an army of one. She has obviously been supported while unemployed by someone. I'm also assuming that they are moving to another location within California, same social services system.

Which is why I strongly suggest that they talk to the Medi-Cal department, find out what is possible before they jump on what is convenient for them and meets their personal preferences (that we be home around our family as soon as possible). Social services do not give extra credit if you've been self supporting before and if you've not filed up to now for other unrelated benefits.

[cbg]

You are correct that when an employee has a qualifying event, such as marriage, they have 30 days to add or subtract, as applicable, any dependents that may be associated with the QE. So in the event of a marriage, the employee has 30 days to add the new spouse; in the event of a birth, they have 30 days to add the newborn, etc. If you miss this window, your next opportunity will be at the next Open Enrollment, whenever that is. The most common time would be sometime in the late fall for a January first effective date; the second most common would be sometime in late May or early June for a July 1 effective date. But it can be at any time; that's established by the insurance policy, not law.

An employer who made a hiring decision on the basis of what medical claims the employee or their dependents would bring to the health insurance, had better have an extremely good non-related reason why the person they hired was a better match for the position because if they can't, they will be subject to very large fines from the Federal government. The US DOL takes ERISA violations VERY seriously and it is absolutely prohibited to make hiring decisions on the basis of what medical claims might or might not exist.

[HighRisk]

Commentator, it would be nice is one of our relatives had enough wealth to quit working to come up here for months to take care of me, but that's not reality for us. Even if it were, we are in a 1-br apartment. By law we can have two adults and one child up to 18 months old here. We'd be violating law to move another adult into this apartment, and it could result in our eviction. Moving where our families are would enable them, and this time has been volunteered, to take shifts staying with me while my fiance is at work. They could still work to support their own households and this baby and I will have the help and care we will need for a while.

We aren't wealthy by a long shot. We are very low income, but are still fairly comfortable due to having cut all unneeded expenses and moving to a smaller apartment. We have absolutely no debt, and gave back the car that did have a balance on it when I was laid off last year. Rent, utilities (electric, gas, phone, internet), gas for the car, insurance, food. These are our expenses.

Our major concern is any time without coverage at all. Right now I'm being monitored weekly. This was a twin pregnancy. I've already lost one baby. I'm being monitored as well for diabetes right now. It wouldn't be good to have to go weeks or months without this needed monitoring. If diabetes does develop and go unchecked, well, that's extremely dangerous.

It's very offensive that you consider this need to move to be a "personal choice" and for personal convenience" when, as it stands, the doctor isn't confident I will live through the delivery. Being on my own for 50 hours a week would only increase the chance that I wouldn't get the care I needed if something happened. But maybe you're one of those who sees wanting to stay alive and raise one's own child to be a "personal choice" and for personal convenience." I didn't take unemployment because we could figure it out on our own, and no one was at any risk. Only now I am in my mid-20's and at risk of dying by the end of the year. If I were your daughter, would you tell me to suck it up and stay put, that wanting to move to increase my chance at staying alive was a ""personal choice" and for personal convenience"?

He also wouldn't be quitting to get me on Medi-Cal. Pretty stupid to do that when we have insurance. He'd be quitting one job to work for another so we can be closer to the care I need with Medi-Cal bridging the gap between leaving one job and getting benefits at another.

[HighRisk]

We considered COBRA. However, it's far FAR outside of anything we could afford. At the end of the month, we have about $400 left over. The difference between our premium now and COBRA is well over $1,000.

[ecmst12]

There is also the option for YOU to move in with your family, and him to stay put until he gets the job transfer or new job straightened out and can join you.

[commentator]

Having gone through a very high risk pregnancy/loss of insurance/loss of baby/possible loss of life due to brain tumor and pregnancy running concurrently in my early years, I do sympathize with you totally. Incidentally, I received a great blessing in that everything did work out, the baby was healthy, the surgery went off without major damage, and we survived and even paid our medical bills. I certainly hope things with your situation resolve as well.

However, I do offer the caution that going to an employer and telling them they have to give you a transfer because your girlfriend needs to be close to her family may not meet the needs of the production process and is definitely going to be considered a personal choice, request, whatever by the employer. They are not required to do anything to make your life better that is not covered by legislation, even if you see it as life and death. Thus it may not suit them to push through your boyfriend's transfer. And if he leaves the job for this reason, this will be considered a "voluntary quit" by definition.

This is why I would encourage you very strongly to speak to someone in the human services department of the state and discuss your eligibility situation. I sincerely feel that keeping the coverage ( and the continued care of your doctors who are familiar with your case) is so primary that it would be very important for your boyfriend to know exactly what he is getting in the case of the insurance for the new job, whether or not he has the job, whether or not he is able to cover you immediately etc. before you do anything. Likewise the Medi-Cal situation. It comes down to the issue of his getting a transfer versus quitting the job. And many a "job he can get" in the new place hasn't come through as planned.

I agree, it would be very dangerous for a company to refuse to hire someone based on their medical situation. Realistically, I do not think it would be a big plus in the current hiring market if you mentioned how badly you needed this job because of your partner's medical situation.